Computational comparison of three different cage porosities in posterior lumbar interbody fusion with porous cage

Abstract

Porous interbody cages, manufactured using additive laser melting technology, have recently been used in lumbar fusion surgery. The major advantage of a porous cage is the presence of space inside the cage for bone ingrowth. However, the biomechanical effects of different porosities on the lumbar segment with and without bone fusion (ingrowth) are still unclear. Hence, the present study aimed to compare the biomechanical responses, including the stress and range of motion (ROM) of the lumbar L3-L4 segments with three different types of porous cages along with a posterior instrument (PI) with and without bone fusion using computer simulation. A lumbar L3-L4 segment model with a PI and porous cages was used in this study. Three different porosities, namely 12.5, 41.2, and 80.84% were used. The diameter of the pores of the porous cage was uniformly set to 0.5 mm. In addition, a traditional PEEK cage was used in this study. Two different bone statuses, with and without bone fusion (ingrowth into the pores of the porous cage and the inner space of the PEEK cage), were considered. The results indicated that although the contact pressure on the bone surface reduced, the cage stress increased with increasing cage porosity. Furthermore, cage stress and contact pressure also increased in cases with bone fusion compared with those without bone fusion. The contact pressure on the bone surface with a cage porosity of 80.8% decreased by 40% (from 943.1 to 575.5 MPa), 37.7% (from 133 to 82.9 MPa), 40.4% (from 690.8 to 412 MPa), and 34.2% (from 533 to 351.1 MPa), respectively, for flexion, extension, lateral bending, and rotation, respectively, compared with that with a cage porosity of 12.5%. The rotational ROM of the PEEK cage with bone fusion was clearly larger than those of the porous cages. Porous cages have recently become popular owing to improved manufacturing technology. This study provides scientific data on the strength and weakness of porous cages with different porosities for clinical use.